PHARM- SAR & perennial rhinitis

Question 1

MOA of 1st gen antihistamines

Answer 1

competes w/ histamine on H1 receptor sites of blood vessels & resp tract

Question 2

drowsiness, cognitive impairment & anticholinergic effects

Answer 2

ADR of 1st gen antihistamines

Question 3

how can a pt minimize ADR of 1st gen antihistamines

Answer 3

using it more; usually taken QHS

Question 4

which is better for congestion– 1st or 2nd gen antihistamines?

Answer 4

1st gen but still not great for congestion

Question 5

name the two 1st gen antihistamines

Answer 5

diphenhydramine
chlorpheniramine

Question 6

are 1st gen antihistamine safe in pregnancy? how about kids?

Answer 6

both are safe in pregnacy
diphenhydramine is for over 3yo, chlor is for over 2 yo

Question 7

indications of nasal corticosteroids

Answer 7

once-daily tx of non-infectious rhinitis
tx & prevention of nasal polyps

Question 8

compare efficacy of antihistamines & nasal steroids for allergic rhinitis

Answer 8

steroids are highly efficacious for it, more effective than mono-therapy with antihistamines

Question 9

4 major sx of allergic rhinitis that is controlled w/ nasal steroids

Answer 9

sneezing
itching
rhinorrhea
congestion

Question 10

does nasal steroid work well for ocular sx?

Answer 10

not really

Question 11

two possible side effects of nasal steroids

Answer 11

nasal dryness
epistaxis

Question 12

how should you use nasal steroids? PRN or daily?

Answer 12

daily but there is tolerance with prolonged use

Question 13

name your 3 nasal steroid

Answer 13

mometasone (nasonex)
fluticasone (flonase)
budesonide (rhinocort aqua)

Question 14

which of the nasal steroids have no mineralocorticoid/androgenic effect?

Answer 14

mometasone

Question 15

which nasal steroid reduces intraepithelial eosinophilia & inflammatory cell infiltration?

Answer 15

mometasone

Question 16

of puff limit with fluticasone

Answer 16

4 puffs/day
for >4 yo

Question 17

which nasal steroid has water to decrease the drying and irritating effect and is better tolerated

Answer 17

budesonide

Question 18

2nd gen antihistamine MOA

Answer 18

same as 1st gen but also works in GI tract

Question 19

how does 2nd gen ADR compare w/ 1st gen

Answer 19

2nd gen has less sedation and anticholinergic effects

Question 20

which class of meds reduce hypersensitivity rxn

Answer 20

2nd gen antihistamine

Question 21

indication for 2nd gen antihistamines

Answer 21

allergic rhinitis (but not nasal congestion)
occupational rhinitis

Question 22

name the 3 second-gen antihistamines

Answer 22

cetirizine (zyrtec)
fexofenadine (allegra)
loratadine (claritin)

Question 23

only mediation for rhinitis that is okay in kids less than 2 years old

Answer 23

cetirizine (zyrtec)– ok in over 6 months old

Question 24

which medication is the most sedating of the 2nd gen antihistamines & has the most SE

Answer 24

certirizine (zyrtec)

Question 25

2nd gen antihistamine age requirements

Answer 25

certirizine (zyrtec): >6 months; >6 yo for adult dose fexofenadine (allegra): >6yo; >12 yo for adult dose loratadine (claritin): >2 yo; >5 yo for adult dose

Question 26

onset & duration of antihistamine nasal sprays

Answer 26

15 min onset up to 4hrs

Question 27

ADR of bitter taste, HA, epistaxis, sedation, irritation

Answer 27

antihistamine nasal spray

Question 28

why are nasal antihistamines 2nd line (3 reasons)

Answer 28

cost ADR less effective compared to nasal steroids

Question 29

name the two nasal antihistamines

Answer 29

azelastine olopatadine

Question 30

are nasal antihistamines safe in pregnacy?

Answer 30

they are category C

Question 31

age requirements with nasal antihistamines

Answer 31

azelastine: 5+ olopatadine 6+

Question 32

how do anticholinergic nasal sprays work?

Answer 32

they inhibit nasal mucous gland secretions great for excessive rhinorrhea

Question 33

mucosal dryness, epistaxis, HA

Answer 33

ADR of anticholinergics

Question 34

2 indicators for anticholinergic nasal sprays

Answer 34

vasomotor rhinitis gustatory rhinitis resolves sx of excessive rhinorrhea ONLY!

Question 35

pregnancy safety and age requirement for anticholinergic nasal sprays

Answer 35

preg cat B 6+ yo

Question 36

name the single anticholinergic nasal spray

Answer 36

Ipratropium

Question 37

which two classes are effective for nasal congestion

Answer 37

intranasal antihistamine intranasal corticosteroid

Question 38

all of these 3 sx are covered by all classes except anticholinergics

Answer 38

itching sneezing rhinorrhea

Question 39

name the two leukotriene receptor antagonists

Answer 39

montelukast (singulair) zafirlukast (accolate)

Question 40

leukotriene antagonist MOA

Answer 40

prevents release of leukotrienes from mast cells & eosinophils

Question 41

leukotriene antagonist/Montelukast indications

Answer 41

seasonal & perennial rhinitis long-term asthma control exercised induced bronchospasms

Question 42

ADR of URI, fever, HA, pharyngitis, cough, abdominal pain, neuropsychiatric/suicidality

Answer 42

montelukast